......The word "classic," in terms of skin cancer, can be very misleading, even costing patients their lives. Doctors and patients alike may fall into the trap of only looking for "classics." Public health education pretty much involves telling patients the "classics" because a few rules and ideas are easier to remember and patients assume "doctors should know the rest." However, it is "knowing the rest" that separates a good doctor from a bad one, and bad doctors are not always easy to spot.

Because of the traps involved with cancers, a patient should seek a skin cancer specialist. One difference between a skin-cancer specialist and any other doctor is that the specialist makes the correct diagnosis close to 100% of the time and the other (non-specialist) doctor often makes the correct diagnosis < 90% of the time. Of course, a 10% failure rate is not acceptable when it comes to life-and-death situations like melanoma. Now, let's get back to the term classic. With a classic form of growth, i.e. a particular pattern or look to the skin, the odds are probably over 90% that the growth a doctor sees is a particular disease.

The problem for the public is the up to 10% that the non-specialist doctor does not recognize correctly. For example, basal-cell carcinoma are classically opalescent, pearly, well-defined bumps that have a few blood vessels growing on the surface. When a growth looks like this, 95% of the time it will be a basal-cell carcinoma in the "classic" form. However, basal-cell cancers may appear in other forms, unfortunately basal-cell cancers usually appear in the "classic" form less than one-third of the time. Therefore, an untrained doctor looking for only the classic signs of basal-cell cancer before making a diagnosis will miss one of every three basal-cell cancers, a 33% failure rate. This high of a failure rate can cause patients a lot of unnecessary mutilation, suffering and malpractice if the cancers that were missed were more advanced. A true skin cancer specialist is experienced with a wide range of skin cancer treatments. This allows the specialist to balance treatment failure rates with potential risks and benefits, as well as insurance and cost concerns. The true specialist will be better able to balance the proper treatment with the patient situation(s) and condition(s).

Even in this Web site, we cannot describe all of the possible variations of skin cancer. We can give patients only a hint as to what is bad so that they may have a hint of the "high index of suspicion" that the world experts have when evaluating skin cancers. Usually, the more cases a doctor has seen, the better honed the doctor's index of suspicion will be. Some patients who "winter" in Florida and "summer" up north recognize this. Often patients believe that Florida dermatologists usually see more skin cancer than dermatologists in northern climes and therefore seek skin-cancer treatments by Florida-based dermatologists who they believe are better at diagnosing skin-cancer and have better sewing or repair techniques.

......Although most skin growths are benign, any new growth on the skin or sore that does not heal should be brought to a doctor's (preferably a Board-Certified Dermatologist's) attention at once to be checked for skin cancer. Skin cancer has many different appearances. For classical examples of how each major category of skin cancer may look, see the individual sections, Basal-Cell Carcinoma, Squamous-Cell Carcinoma and Melanoma.

......Many skin cancers begin as small, waxy lumps that eventually bleed and crust, or as dry, scaly red patches. Unfortunately, these are rather crude and limited descriptions. Photographs are worth a thousand words when trying to understand skin-cancer detection, so please refer to the photos. Also, a skin-cancer may be very small at first, and later may become very large. Tumor size is frequently not a helpful indicator.

......Skin cancer sometimes forms from a precancerous skin condition called "actinic keratosis." See Precancers. Therefore, cancers may be seen colliding (associated) with precancers and even, by chance, with other growths. Precancers (actinic keratoses) are classically pink, red or occasionally brown, rough patches of skin, usually with dry scale, that develop as a result of sun damage to the skin. Actinic keratoses are commonly found on the face, neck and hands.

......If the doctor thinks that a skin growth may be a cancer, he/she performs a biopsy. The whole lesion, or often more preferably a small INcisional sample of the suspicious tissue is surgically removed and sent for examination under the microscope. This biopsy is used to confirm or rule out a diagnosis of cancer and to determine its type.